Repeat Contraception Prescription Request

Order your repeat contraception prescription online with the form below. You must be registered with the Practice before we can accept your request.

Please note: For reasons of privacy this form will not store your details or medication request. There is no email acknowledgement with this service. Once you send this form a notification message will appear to indicate successful submission. It is important to enter your correct email address failure to do so will result in non-delivery of your request.

Contraception prescription request
Please use format day/month/year e.g. 12/05/1979
e.g. Combined Pills – Microgynon (or Microgynon equivalent such as Rigevidon, Ovranette, Levest), Cilest, Mercilon/ Gedarel, Loestrin 20/30, Brevinor/ Ovysmen, Femodene, Yasmin. Progestogen-Only Pills – Desogestrel/ Cerazette, Femulen, Norgeston, Micronor/ Noriday, Microval.
Please arrange this with your pharmacy

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.
Please note: For reasons of privacy this form will not store your details or medication request. There is no email acknowledgement with this service. Once you send this form a notification message will appear to indicate successful submission.